Leaving Medicine

The shocking news is this: I’m leaving clinical medicine.

For the last few months, instead of applying to the residency match, I created a startup that has the goals of improving access to healthcare for citizens living in big metropolitan cities in the US. Its called Shout and you can find out more about it if you want at this link.

I wonder what you’re thinking right now. You’re probably either horrified, mildly astonished, bored, or disappointed. When I told my uncle, a pulmonologist, about my plans, he said “Well. At least you have guts.” Most of my friends and family were pretty worried at first. I think I understand why — they had really started to envision me as a doctor, and now they had to envision me as an unemployed person with lofty goals ahead.

The truth is, I know I’ll be happier now. I have been thinking about switching out of medicine for a very long time, but I was terrified of making the jump. When I applied to medical school 5 years ago, I thought I would enjoy being a doctor because I really cared about humans and their problems. I did my BSc in Physics right before medical school and it had left me feeling a bit far removed from problems I cared about. Graduate research in physics and other hard sciences seemed to require a certain kind of focus on inanimate problems that I didn’t have. I wanted to work on less complex but truer-to-real-life problems. So as the time came to decide whether or not to continue on to graduate school… I went to the other extreme of science and jumped headfirst into a field that left almost no room for sitting with a pen and paper in a silent room.

But it turned out medicine wasn’t really my calling, and furthermore, that it was the type of all-consuming romance that could only last if sustained by true love. It’s really hard to admit to yourself that you’ve married the wrong career- so I tried to laugh it off, to forcibly change myself, to unfurl my mind and carefully re-shape it so that it fit around the curves of clinical medicine. It didn’t work. My mind constantly unstuck itself from the subject matter at hand and drifted off … away from patients and their infections and their cancers and clinical presentations and their biologies. It floated away, high off in the atmosphere in the clouds — in a place where you can see the big picture but you can’t reach down to earth and remember what antibiotic to prescribe or for how many days.

I still trudged through hospital hallways stumbling over the social problems that infected all my patients but that I was never really in charge of addressing. And I struggled every day to show up and perform adequately at tasks that gave me no joy when I finished them.

I kept powering through it in the stubborn hope that it would improve. I was pretty unhappy as a 1st year medical student… and as a 2nd year one. They said things would get better 3rd and 4th year but when clinical rotations came, I became even unhappier. My friends and colleagues reassured me that being a staff physician would be way better and I could always find the niche that satisfied me, but I began to see a fundamental pattern that I couldn’t avoid anymore. There was a tunnel at the end of every tunnel, and all of them led to more medicine.

Practicing as a physician turned out to be more fast-paced and hierarchical and procedural than I’ll ever naturally be. Which it has good reason to be, because how in the world could you lead a Code Blue while asking everyone for their opinion?

Let me emphasize that being a physician is a wonderful, important, valuable career for the right people. My older brother is an ER physician, and even when he is extremely stressed out, he shines in his role and becomes even more productive somehow. I on the other hand — didn’t shine under the stress of clinical work. I became dull and foggy-headed and unproductive. I’d never been fully happy as a medical student, and much of the time I had been miserable.

Had I been in any other job, grad school, or situation, I probably would have left way before now, right? Why sign up to work 70 hour weeks and give up your weekends, your hobbies, your mental health, your ability to be supportive for your family and significant other… for a job that made you into a worse person? Well…. medicine is really hard to leave. REALLY hard. There are good and bad aspects of clinical medicine that make it that way.

First I’ll explain the good:

It’s really an amazing career for people who like other people. I love people, so I thought I kept thinking I should stay. I like to think I’m a compassionate human and I care about social justice. As a potential-doctor, I got to study social disparities first-hand all the time. I had intimate access to people and their lives and their stories. I had the chance to make a small difference for them each day.

Doctors are always valuable, and everyone wants to be valued. In any country around the world, and in times of both bounty and strife, societies need doctors. Doctors are the last professionals who are still holding out in war-torn Syria. If you had to assemble a team for the apocalypse, you’d definitely want a doctor on it.

You have job security and good pay. As a millenial facing the ugliest job market ever, need I say more?

Now I’ll list the bad reasons why clinical medicine is hard to leave even when you really really should.

Having an MD doesn’t qualify you for much else besides traveling further down the pipeline of clinical medicine. If you want to leave… you either have to learn an entirely new skill, get a PhD and go do research, or else you are going to have to get creative as hell and there’s a big chance that you’ll fail.

You’re surrounded by colleagues and friends who love medicine and hate uncertainty. For 4 years, I went to school with the brightest minds who had such 100% guaranteed, well-performing futures devoid of any risk that the Royal Bank of Canada was willing to give you a $240,000 line of credit as soon as you started your first day of class.

Pride. Everyone has it, and I do too. If you leave a job where you were 90% cool (superseded in my mind only by astronauts, Elon Musk types of entrepreneurs, successful artists/celebrities, and professors of astrophysics/neuroscience/evolutionary bio) then there’s a 90% chance that the next thing you do will be less cool. The good news is : who cares? Job coolness is an abstract construct that I made up and became a slave to. You might be doing the most valuable work in the world and you might meet someone who is too uninformed or different from you to appreciate it. That doesn’t mean you should stop, right?

Sunk-Cost Fallacy — you just spent 4–8 of the most intense years of your youth in a pipeline to become a doctor. It takes a long time to get over the denial phase and get ready to start from (almost) scratch.

It took me a while to think about all of these things. To be more exact, it took me about 1.8 years. During that time I had to answer the question: what do I want to do with my life instead? The answer is I want to help create technology and spread information that makes medicine better: more effective, transparent, and more accessible to marginalized populations. What I want to work on is civic technologies in the healthcare sphere — Dimagi is an example of a company that does the kind of innovation that I want to be a part of.

Going to medical school has had invaluable benefits for me even though I am not planning to practice clinically. We often go through life in search of a meaningful problem to solve, and I believe I found that problem because I went to medical school. I am incredibly grateful for that. Also, I have been exposed to an incredibly broad spectrum of human emotion and people from unbelievably diverse backgrounds. I have had the chance to intimately observe the problems inside a social system that all humans end up encountering — because everyone gets sick. I don’t see how I could possibly fail to benefit from what I’ve learned in the last four years.

Will I miss clinical medicine? Yes. But I know I’ll feel much happier as a problem-solver who might have a small, finite chance of improving medicine. And I know it’s going to be immensely difficult and on the verge of impossible at times. But as Lao Tzu said, the journey of a thousand miles begins with a single step. Call me naive if you want, but I’m prepared to walk a thousand miles.